title: A retrospective analysis of the costs and management of genital warts in Italy.
abstract: BACKGROUND
  In Italy the prevalence of genital warts in women (15-64 years) is approximately 0.6% with an incidence of 0.4% per year. Treatments for GW are usually long, with moderate success and high costs. The aim of the study was to evaluate the diagnostic-therapeutic pathway, duration and setting of treatment, costs of episodes of condyloma in a population attending a regional STI clinic in Piedmont.
  
  
  METHODS
  This was a retrospective observational study conducted using medical records of outpatients who first visited the STI Clinic of San Lazzaro Dermatological Hospital in 2008. The patients' medical histories were analysed for episodes that occurred and were cleared in 18 months following the initial visit. Data on screening methods for STIs, type of diagnosis for condyloma, treatment type, treatment setting, and anatomic lesion site were obtained from medical records. The costs were calculated for each episode.
  
  
  RESULTS
  A total of 450 episodes were analysed (297 men,153 women). The most frequently affected anatomic site was the genital area (74%) in both genders. With regard to treatment setting, 78.44% of patients received outpatient treatment at the STI clinic, 4% were treated at home, and 0.22% were hospitalised; 11.11% were treated in multiple settings. The mean number of treatments per episode was 2.03; although many patients received only 1 treatment (n = 207, 46%), exspecially cryotherapy or diathermy coagulation (64.73% versus 28.02% of episodes, respectively). The mean episode duration was 80.74 days. The mean cost (in 2011 euros) for an episode was €158.46 ± 257.77; the mean costs were €79.13 ± 57.40 for diagnosis and €79.33 ± 233.60 for treatment. The mean cost for treatment in a STI-Clinic setting was €111.39 ± 76.72, that for home treatment was €160.88 ± 95.69, and that for hospital care was €2825.94.
  
  
  CONCLUSIONS
  The treatment of and associated costs for genital warts are significant. Several factors affect the cost, and internal STI clinic protocols, such as the 6 month window used to consider a recurrence or new diagnosis, create bias. Nonetheless, our findings how costs similar to those reported in the international literature and should be considered when deciding on which HPV vaccination programs should be provided by the public health system.
authors.affiliation: Department of Public Health and Paediatrics Sciences, University of Turin, Via Santena 5 bis, Turin 10126, Italy. mariola.gianino@unito.it.
authors.forename: Maria Michela
authors.initials: MM
authors.lastname: Gianino
authors.forename: Sergio
authors.initials: S
authors.lastname: Delmonte
authors.forename: Emanuela
authors.initials: E
authors.lastname: Lovato
authors.forename: Morena
authors.initials: M
authors.lastname: Martinese
authors.forename: Sabrina
authors.initials: S
authors.lastname: Rondoletti
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Bernengo
authors.forename: Carla Maria
authors.initials: CM
authors.lastname: Zotti
mesh_terms: D000293:Adolescent; D000328:Adult; D003218:Condylomata Acuminata / Q000191:economics* / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult